A systematic review of trials currently investigating therapeutic modalities for post-acute COVID-19 syndrome and registered on WHO International Clinical Trials Platform.

BACKGROUND: Post-acute COVID-19 syndrome (PACS) is a well-recognized, complex, systemic disease which is associated with substantial morbidity. There is a paucity of established interventions for the treatment of patients with this syndrome. OBJECTIVES: To systematically review registered trials currently investigating therapeutic modalities for PACS. DATA SOURCES: A search was conducted up to the 16 September, 2022, using the COVID-19 section of the WHO Internal Clinical Trials Registry Platform. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Interventional clinical trials of any sample size examining any therapeutic modality targeting persistent symptoms among individuals after diagnosis with COVID-19. METHODS: Data on trial characteristics and intervention characteristics were collected and summarized. RESULTS: After screening 17 125 trials, 388 trials, from 42 countries, were eligible. In total, we had 406 interventions, of which 368 were mono-therapeutic strategies, whereas 38 were intervention combinations. Among 824 primary outcomes identified, there were >300 different outcomes. Rehabilitation was the most employed class of intervention in 169 trials. We encountered 76 trials examining the pharmacological agents of various classes, with the most common agent being colchicine. Complementary and alternative medicine encompassed 64 trials exploring traditional Chinese medicine, Ayurveda, homeopathic medications, naturopathic medications, vitamins, dietary supplements, and botanicals. Psychotherapeutic and educational interventions were also employed in 12 and 4 trials, respectively. Other interventions, including transcranial direct current stimulation, transcutaneous auricular vagus nerve stimulation, general electrical stimulation, cranial electrotherapy stimulation, various stem cell interventions, and oxygen therapy interventions, were also employed. CONCLUSION: We identified 388 registered trials, with a high degree of heterogeneity, exploring 144 unique mono-therapeutic interventions for PACS. Most studies target general alleviation of symptoms. There is a need for further high-quality and methodologically robust PACS treatment trials to be conducted with standardization of outcomes while following WHO's recommendation for uniform evaluation and treatment.

Profile of People Who Inject Drugs in Tehran, Iran.

The marked shift in the patterns of drug use in Iran, from opium smoking to injecting drug use, has led to serious health-related outcomes. This study was designed to explore characteristics of people who inject drugs (PWID) in Tehran, Iran. Nine hundred and four PWID were recruited from treatment and harm reduction facilities, as well as drug user hangouts in public areas in Tehran. Participants were interviewed using the Persian version of the World Health Organization Drug Injecting Study Phase II questionnaire. The median age at the time of the first illegal drug use, at the time of the first injection and current age was 20, 24 and 32, respectively. In more than 80% of the cases, the first drug used was opium. The transition from the first drug use to the first drug injection occurred after an average of 6.6 and 2.7 years for those who had started drug use with opium and heroin, respectively. Two-thirds of the participants shared injecting equipment within the last 6 months. Difficulty in obtaining sterile needles and thehigh cost of syringes were reported as the major reasons for needle/syringe sharing. Approximately 80% of community-recruited PWID reported difficulties in using treatment or harm reduction services. Self-detoxification and forced detoxification were the most common types of drug abuse treatment in alifetime. Despite a dramatic shift in drug policy in Iran during the past few years, wider coverage of harm reduction services, improvement of the quality of services, and education about such services are still necessary.

Pharmacodynamics of a single low dose of long-acting recombinant follicle-stimulating hormone (FSH-carboxy terminal peptide, corifollitropin alfa) in women with World Health Organization group II anovulatory infertility.

In a double-blind, placebo-controlled, randomized study, 55 anovulatory subjects received a single s.c. injection of placebo (n = 10) or recombinant long-acting FSH [FSH-carboxy terminal peptide (CTP), ORG 36286, corifollitropin alfa; NV Organon, The Netherlands] in doses of 7.5 (n = 13), 15 (n = 10), 30 (n = 11), or 60 microg (n = 11). The injection was given 2 or 3 d after the onset of a spontaneous or progestagen-induced withdrawal bleed. After drug administration, the induced follicular response varied widely among subjects in each dose group. The percentage of subjects with a follicular response (at least one follicle > or = 10.0 mm) increased with the dose (P < 0.01) and was 10, 31, 70, 73, and 82% in the placebo and 7.5-, 15-, 30-, and 60-microg treatment groups, respectively. In responding subjects, the average maximum number of follicles was 4.0, 7.6, 13.4, and 20.0, respectively, which was reached at 6.5, 6.9, 6.6, and 8.2 d after a single dose of 7.5, 15, 30, and 60 microg FSH-CTP, respectively. The dose-response for the number of follicles was statistically significant within the dose range tested (P < 0.01). Peak serum inhibin-B levels were significantly correlated with serum estradiol (E2) levels (r = 0.84, P < 0.01), and peak concentrations of inhibin-B and E2 correlated with the number of follicles observed at the same time point (for both hormones; r = 0.47, P < 0.01). Overall per treatment group, serum E2 and inhibin B concentrations significantly increased only in the two highest FSH-CTP dose groups, reaching peak concentrations at d 3 in the 30-microg group and at d 5 in the 60-microg group. Thereafter these hormone values declined rapidly, returning to baseline within 1 wk after FSH-CTP administration. In total, nine of the 55 treated subjects (16.4%) ovulated after drug administration: one subject in the placebo group, two subjects in the 7.5-microg group, three subjects in the 15-microg group, two in the 30-microg group, and one in the 60-microg group. Three subjects had monofollicular ovulation after placebo (n = 1) and a single dose of 15 microg FSH-CTP (n = 2). In two subjects with too many preovulatory follicles, (multiple) ovulation was prevented by GnRH antagonist administration. Thus, a single low dose of long-acting FSH-CTP was able to induce one or more follicles to grow up to ovulatory sizes, but the anovulatory status was not reversed because the incidence of subsequent (mono)ovulations was low.

Processos psicossociais da aquisição de uma deficiência / Psychosocial processes of acquiring a disability / Procesos psicosociales de la adquisición de una discapacidad

A aquisição de uma deficiência pode ter extenso impacto na vida de uma pessoa, pois ocorre, muitas vezes, sob condições traumáticas e obriga tanto a ressignificações subjetivas quanto a adaptações práticas no cotidiano. O principal objetivo do trabalho aqui descrito consistiu em compreender aspectos psicossociais do processo de aquisição de uma deficiência, considerando diversos fatores que podem interferir nestas experiências. Para a realização da pesquisa, foram entrevistadas, de forma semiestruturada, 13 pessoas que adquiriram uma deficiência física, auditiva ou visual na idade adulta, sendo os relatos analisados pelo método de análise de conteúdo. Ao se discutir as falas dos pesquisados, são traçadas algumas semelhanças e distinções entre as experiências dos participantes, buscando também tecer considerações com base na literatura acadêmico-científica sobre o tema. Observou-se que os processos psicossociais de aquisição da deficiência foram permeados tanto por sentimentos negativos, relacionados à angústia e à depressão, bem como por reações mais harmônicas e de valorização da vida, em que se relativiza a perda do membro ou da capacidade sensorial. Representando um momento marcante na vida de quem a adquire, a deficiência pode levar à aprendizagem e ao amadurecimento, à medida que o tempo após a aquisição aumenta. Entende-se que os estudos acerca da deficiência, em especial a adquirida, devem ser ampliados e aprofundados, tendo em vista que o campo de estudos sobre esta temática ainda precisa de mais contribuições a respeito.(AU)

Becoming disabled may cause a considerable impact in someone's life, because, in most of the cases, it happens under traumatic conditions and it results in subjective resignification and practical adaptations. The main objective of this study is to understand the psychosocial aspects involved in becoming disabled, considering several factors which may interfere these experiences. For this research, 13 people who got a physical disability, a hearing or visual impairment in adulthood were interviewed in a semi-structured way and the results were evaluated using the content analysis method of Bardin (2011). When the speeches of the interviewed people are evaluated, some comparisons and distinctions among experiences of the participants are made for establishing relations with academic-scientific literature on this theme. It was noticed that the psychosocial processes involved in becoming disabled were permeated by negative feelings related to anguish and depression, as well as more harmonic reactions and valorization of life, in which the loss of a member or of a sensorial capability is relativized. As a defining moment in the lives of those who acquired it, the disability may result in learning and maturating over the years after the event. It is recommended that the studies concerning disability, especially the acquired ones, get broadened and deepened because there is a need for more contributions about this subject.(AU)

La adquisición de una discapacidad puede tener un amplio impacto en la vida de una persona, pues ocurre, muchas veces, bajo condiciones traumáticas y requiere tanto la reinterpretación subjetiva como las adaptaciones prácticas en la vida cotidiana. El principal objetivo del trabajo que se describe aquí fue entender los aspectos psicosociales del proceso de adquisición de una discapacidad, teniendo en cuenta diversos factores que pueden interferir en estas experiencias. Para la investigación, fueron entrevistadas de manera semiestructurada, 13 personas que adquirieron una discapacidad física, auditiva o visual en la edad adulta, siendo los relatos analizados por el método de análisis de contenido. En la discusión de los relatos de los entrevistados, son trazadas algunas similitudes y diferencias entre las experiencias de los participantes, buscando también tejer consideraciones con base en la literatura académica y científica sobre el tema. Se observó que los procesos psicosociales de adquisición de la discapacidad fueron permeados tanto por sentimientos negativos relacionados con la angustia y la depresión, así como por las reacciones más armónicas y de valorización de la vida, en que se relativiza la pérdida de un miembro o la capacidad sensorial. Representando un momento decisivo en la vida de quién la adquiere, la discapacidad puede llevar al aprendizaje y al crecimiento, a medida que el tiempo después de la adquisición aumenta. Se entiende que los estudios acerca de la discapacidad, en especial la adquirida, deben ser ampliados y profundizados, teniendo en cuenta que el campo de los estudios sobre este tema aún necesita más contribuciones al respecto.(AU)

Establishment of the first international standard for nucleic acid amplification technology (NAT) assays for HCV RNA. WHO Collaborative Study Group.

BACKGROUND AND OBJECTIVES: The aims of this study were the establishment of a WHO International standard for HCV RNA for nucleic acid amplification technology (NAT) assays and the determination of the HCV RNA content of the candidate standard. MATERIALS AND METHODS: Twenty-two laboratories evaluated three candidate materials (two lyophilised, AA and BB, which were derived from the same source and one a liquid preparation, CC). All samples were HCV genotype 1 with a concentration of approximately 10(5) genome equivalents/ml. The methods used included the Roche Amplicor assay (version 1), Chiron Quantiplex (bDNA) assay, Organon Teknika NASBA assay, Transcription Mediated assay and various in-house assays, using single or nested primers. RESULTS: There was reasonable agreement between the overall mean NAT detectable units/ml obtained by the different assays except for some of the in-house assays using single primers which gave substantially lower estimates. These titres were 5.0 log10 for samples AA and BB and 4.6 log10 for sample CC. CONCLUSIONS: Sample AA was accepted as the candidate standard and assigned a titre of 10(5) international units (IU)/ml. The International Standard consists of a batch of vials each containing 50,000 IU/vial. Preliminary studies indicated that the material is stable at +4 degrees C and +20 degrees C for up to 200 days.

[WHO guidelines for governments and consumers regarding the use of alternative therapies]. / Recomendaciones de la OMS para gobiernos y consumidores acerca del uso de los tratamientos tradicionales.

Herbal remedies and other alternative treatments, such as acupuncture and homeopathy, are widely used in traditional societies and are becoming immensely popular in developed countries as well. Most are cheap, readily available, easy to use, and are perceived to be "healthier" than pharmaceutical substances. However, users need to be better informed as to the actual benefits and properties of these forms of therapy and their potential hazards. Improper use puts consumers at risk for potentially serious side effects as a result of allergy, drug interactions, contamination of the products with pesticides, heavy metals, and other substances, or trauma inflicted by inexperienced or poorly trained practitioners. Some traditional remedies can cause undesirable effects, such as excessive bleeding. Thus, it is essential that users have access to the information that is reliable, clear, and easily available. In June of this year the World Health Organization released a new set of guidelines to help national health authorities develop and distribute this type of information. The Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine, which were developed with the financial and technical support of the Government of Lombardy, Italy, and the Government of Sweden, are part of a collaborative project that seeks to promote the proper use of traditional, complementary, and alternative therapies by consumers. In addition to offering advice for government officials on how to prepare reliable consumer information, the guidelines contain a series of simple questions that can guide users through the process of deciding on the use of such therapies. The guidelines are published in English at the World Health Organization's website: http://www.who.int/en/

Male contraceptive research steps back into spotlight.

PIP: The goal of male hormonal contraception is to block spermatogenesis by suppressing the secretion of pituitary gonadotropins. Prospects are good for the development of such a male contraceptive, with at least one hormonal contraceptive for men potentially available within 5-7 years. Finding an acceptable, reversible, and preferably long-lasting hormonal contraceptive for men is a top priority of the World Health Organization (WHO). Considerable evidence suggests that an androgen, with or without a progestogen, can provide effective contraception and is well tolerated. Schering and Organon are planning to collaborate with WHO in developing hormonal contraception for men. Fred Wu of the University of Manchester, UK, will soon begin a trial comparing the effectiveness of new injectable testosterone undecanoate and testosterone buciclate formulations, with or without synthetic progestogens.^ieng

Recomendaciones de la OMS para gobiernos y consumidores acerca del uso de los tratamientos tradicionales / WHO guidelines for governments and consumers regarding the use of alternative therapies

Herbal remedies and other alternative treatments, such as acupuncture and homeopathy, are widely used in traditional societies and are becoming immensely popular in developed countries as well. Most are cheap, readily available, easy to use, and are perceived to be "healthier" than pharmaceutical substances. However, users need to be better informed as tothe actual benefits and properties of these forms of therapy and their potential hazards. Improper use puts consumers at risk for potentially serious side effects as a result of allergy, drug interactions, contamination of the products with pesticides, heavy metals, and other substances, or trauma inflicted by inexperienced or poorly trained practitioners. Some traditional remedies can cause undesirable effects, such as excessive bleeding. Thus, it is essential that users have access to information that is reliable, clear, and easily available. In June of this year the World Health Organization released a new set of guidelines to help national health author ities develop and distribute this type of information. The Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine, which were developed with the financial and technical support of the Government of Lombardy, Italy, and the Government of Sweden, are part of a collaborative project that seeks to promote the proper use of traditional, complementary, and alternative therapies by consumers. In addition to offering advice for government officials on how to prepare reliable consumer information, the guidelines contain a series of simple questions that can guide users through the process of deciding on the use of such therapies. The guidelines are published in English at the World Health Organization's website: http://www.who.int/en/